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11:35
The Multiple Sclerosis Performance Test (MSPT): An iPad-Based Disability Assessment Tool
Published on: June 30, 2014
MS Forum/MS Over the Past 17 Years
1Barry GW Arnason Department of Neurology Surgery Brain Research Institutes 5812 South Ellis Avenue SBRI J209 (MC 2030) Chicago, IL 60637 USA Tel: +1 773 702 6386 Fax: +1 773 702 9060
International MS Journal
|June 22, 2011
Summary
Multiple sclerosis (MS) treatments before 1990 focused on T-cells, while 1990-2010 drugs target relapses but not progressive disability. Current MS therapies need new strategies for progressive disease.
Area of Science:
- Neuroimmunology
- Multiple Sclerosis Pathogenesis
- Therapeutic Development
Background:
- Pre-1990 understanding of MS involved genetic predisposition (HLA), suspected environmental triggers (Epstein-Barr virus), and T-cell involvement in relapses.
- Early treatments like ACTH and steroids showed some efficacy in reducing relapse severity, but T-cell inhibitors (cyclosporine) failed in progressive MS.
- The 1990-2010 era saw the introduction of disease-modifying therapies (DMTs) such as interferon-beta and glatiramer acetate, followed by natalizumab and fingolimod.
Purpose of the Study:
- To review the evolution of understanding and treatment of multiple sclerosis (MS) before and after the immunomodulatory era.
- To discuss the limitations of current MS therapies in addressing progressive disability.
- To explore future directions for MS treatment strategies.
Main Methods:
- Review of historical data and clinical trial outcomes related to multiple sclerosis.
- Analysis of the efficacy of various immunomodulatory treatments in reducing MS attack frequency and new lesion accumulation.
- Examination of the underlying mechanisms of progressive MS, including brain atrophy and cognitive loss.
Main Results:
- Disease-modifying therapies approved between 1990-2010 effectively reduce MS relapse frequency and new lesion formation.
- Despite advancements, current MS treatments have not demonstrated efficacy in reducing disability progression in progressive MS.
- Progressive MS pathology, including brain atrophy and axonal damage, appears to be driven by innate immune system activation, not T-cells.
Conclusions:
- Significant progress has been made in managing relapsing forms of MS, but effective treatments for progressive MS remain elusive.
- The failure of T-cell-targeted therapies in progressive MS suggests a shift in pathogenic mechanisms.
- Novel therapeutic strategies targeting the innate immune system are required to address disability progression in multiple sclerosis.
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